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Medicaid

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PMRNC:
Michelle, I heard the same thing..but when I called Medicaid, they told me that would only be if the patient had Medicaid Primary..If they have a medicaid managed care plan (either primary or secondary) it is up to them to go to an in network provider.  I very rarely have this come up, and my clients (all but one) accepts Medicaid (FOR NOW) I could never find documentation of that either anywhere. But we also don't know this person is in NY

 

Michele:
Actually, we called today too to verify.  THey told me that if the patient is informed up front, the provider and patient mutually agree, then they can be charged for services not covered.  They recommended that the provider have the agreement in writing signed and put in the patient's chart.

Learn something new every day!   ;D

PMRNC:
Michelle, right that's what they told me but then I asked where I can view that and they had no clue, they passed me on to another rep who told me that's it's just an advisement.. so when I said.. ok then if we don't have an agreement we can bill the patient and she said "Well I guess technically you can".  ??? :o

dekenn:
Here's another one of those secondary questions.. Sorry, I seem to have a lot of them lately   :)

We have a patient that had surgery, 4 separate procedures.
Medicare is her primary, and they allowed and paid their portion for all 4 procedures.
Horizon NJ Health (managed medicaid program) is her secondary... According to their policy, they pay 100% of first procedure, 50% of second procedure and 25% of third procedure. No other procedures will be paid. period. doesn't matter if it was processed by medicare and that it's a legitimate bill.
So, they only covered half of what medicare said was patient responsibility for the 3rd procedure and none for the 4th.
Can I bill the patient????   ???

PMRNC:
What does the 2ndary say for patient responsibility? I'm thinking in this instance you can bill patient up to the patient balance portion from the Medicare EOB.

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